Achilles tendon rupture.docx

Introduction Rupture probably occurs only if the tendon is degenerate. Consequently, most patients are over 40 years old. While pushing off (running or jumping), the calf muscle contracts; but the contraction is resisted by body weight and the tendon ruptures. The patient feels as if he or she has b...

Introduction Rupture probably occurs only if the tendon is degenerate. Consequently, most patients are over 40 years old. While pushing off (running or jumping), the calf muscle contracts; but the contraction is resisted by body weight and the tendon ruptures. The patient feels as if he or she has been struck just above the heel and is unable rise up on tiptoes. Clinical picture A gap can be seen and felt about 5 cm above the insertion of the tendon. Plantarflexion of the foot is weak and is not accompanied by tautening of the tendon. Simmonds’ test is helpful with the patient prone, the calf is squeezed; if the tendon is intact the foot is seen to plantarflex involuntarily; if the tendon is ruptured the foot remains still. Treatment If the patient is seen early, the ends of the tendon may approximate when the foot is passively plantarflexed. If so, a plaster cast is applied with the foot in equinus and is worn for 8 weeks; thereafter, a shoe with a raised heel is worn for a further 6 weeks. Operative repair is probably more reliable, but immobilization in equinus for 8 weeks and a heel raise for a further 6 weeks are still needed.